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General NPI Number Information
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NPI Number | 1013694561
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Entity Type | Individual
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Provider Name | HARVEY DEDEMADIZ
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Gender | Male
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 2500 SW 107TH AVE STE 42
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City | MIAMI
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State | FL
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Zip | 33165-2492
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Country | US
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Telephone | 305-927-4643
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Fax |
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Provider Business Mailing Address
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Address Line | 14256 SW 162ND ST
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City | MIAMI
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State | FL
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Zip | 33177-1817
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Country | US
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Telephone | 305-927-4643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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